Think Tank Jettisoning rev limiters in the
race toward fi scal health What strategies, tactics boost revenue cycle management operations?
By Rick Dana Barlow If you thought accountability and accounting accuracy
were challenging enough before the Affordable Care Act took effect, then expect your efforts and tension to acceler- ate into overdrive starting this year.
Another one-year delay for converting to ICD-10 codes
offers little consolation or relief either. Historically, healthcare organizations around the nation maintain and operate two distinct databases. On the rev- enue cycle side, one houses all of the charges assigned and attributed to patients. On the expense management side, the other houses much, if not all, of the products and services purchased for clinicians to use on patients and for administrators to use for day-to-day operations. Typically, these databases remain in distinct fi efdoms.
However, a small but growing number of organizations striv- ing to become more effi cient in recording fi nancial income and outcomes and process improvement for higher-quality patient care are looking to connect those data streams to reinforce accuracy and balance on the balance sheet. As revenue streams ripple and fl atline under the auspices of healthcare reform while expenses continue to increase, healthcare organizations continually look for ways to fortify both sides of the balance sheet through process improve- ment that includes information technology. In a nutshell, those efforts may be easier said than done
due to a variety of variables, including programming, func- tional borders and, quite frankly, egos.
So what can and should IT executives do to address these issues and improve revenue cycle management? Health Management Technology sought to explore tangible and actionable strategies and tactics by reaching out to more than a dozen healthcare IT executives that specialize in revenue cycle and supply chain management operations. To start, HMT asked the group to defi ne their under- standing of revenue cycle management and all that it might encompass. It offered them fi ve “standardized” options from which to choose, and then gave them the opportunity to correct or supplant the multiple-choice selections with something more creative and open-ended. The standard- ized answers to what revenue cycle management means included: • Maintaining common procedure pricing across all facilities
• Billing, claims processing, patient charge capture and payment
• Minimizing the impact of reimbursement cuts and payer mix migration
• Sharing databases between billing, accounts payable, clinical EHR/EMR, revenue cycle and supply chain
How do you defi ne revenue cycle management?
Patrick Campbell, Product Manager, MedAptus Inc.
Campbell: I think about revenue cycle manage- ment in the broadest possible sense: Managing the process of collecting revenue in order to achieve maximum appropriate reimbursement for the services provided. Sharing data is a good place to begin, but truly eff ecting change requires not just data but also a comprehensive toolbox of technology, analysis and personnel. It’s not enough to have a great charge capture solution or reporting suite, it’s critical to have the people who can analyze and adjust workfl ow.
8 June 2014
John Dragovits, Senior Vice President and General Manager, Revenue Cycle, Allscripts Healthcare Solutions Inc.
Dragovits: Due to the changing market dy- namics, revenue cycle management needs to be viewed in a much broader sense. No longer can departments, staff and other stakeholders maintain their own processes and data. It all needs to be shared and must fl ow through the entire healthcare process to realize the transi- tion into value-based care. We believe that rev- enue cycle management is all of these things and much more. It starts when the patient engages with their care-giver, fl ows through to their visit and during care, and then fi nishes on the back end until the payment is made. T e process encompasses portals, registration, scheduling, patient care, billing, payment and even after-care.
HEALTH MANAGEMENT TECHNOLOGY www.healthmgttech.com
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